Broken wrist surgery

Distal Radius Fractures (Broken Wrist)

What is a Distal Radius Fracture (Broken Wrist)?

The radius is the larger of the two bones of the forearm. The end toward the wrist is called the distal end. A fracture of the distal radius occurs when the area of the radius near the wrist breaks. Distal radius fractures are very common. In fact, the radius is the most commonly broken bone in the arm.

A distal radius fracture almost always occurs about 1 inch from the end of the bone. The break can occur in many different ways, however.

One of the most common distal radius fractures is a Colles fracture, in which the broken fragment of the radius tilts upward.

Other ways the distal radius can break include:

. Intra-articular fracture. A fracture that extends into the wrist joint. ("Articular" means "joint.")

. Extra-articular fracture. A fracture that does not extend into the joint is called an extra-articular fracture.

. Open fracture. When a fractured bone breaks the skin, it is called an open fracture. These types of fractures require immediate medical attention because of the risk for infection.

. Comminuted fracture. When a bone is broken into more than two pieces, it is called a comminuted fracture.

It is important to classify the type of fracture, because some fractures are more difficult to treat than others. Intra-articular fractures, open fractures, comminuted fractures, and displaced fractures (when the broken pieces of bone do not line up straight).are more difficult to treat, for example.

Sometimes, the other bone of the forearm (the ulna) is also broken. This is called a distal ulna fracture.

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Before Distal Radius Fracture (Broken Wrist) Surgery

Signs and symptoms of a distal radius fracture

Symptoms of a fracture to the distal radius are almost always instantly visible at the time of injury. The different types of fractures will vary slightly from minor to severe, but symptoms of more severe fractures are generally very similar:

. Immediate pain

. Swelling

. Tenderness

. Bruising

. Loss of function

. Visible deformity/limp wrist

Causes

How a Wrist fracture can occur?

The most common cause of a distal radius fracture is a fall onto an outstretched hand and often need manipulation/plaster cast or internal fixation with a small plate.

Osteoporosis, a disorder in which bones become very fragile, can mean that a relatively minor fall results in a broken wrist. Many distal radius fractures in people older than 60 years of age are caused by a fall from a standing position.

A broken wrist can happen even in healthy bones if the force of the trauma is severe enough. For example, a car accident, a fall off a bike or activities like snowboarding may generate enough force to break a wrist. Good bone health remains an important prevention option. Wrist guards may also help to prevent some fractures, in sporting activities like snowboarding for example, but they will not prevent them all.

Diagnosis

How are distal radius fractures diagnosed?

Your provider will take a detailed health history and perform a physical evaluation. X-rays will be taken to confirm a fracture and help determine a treatment plan. Sometimes an MRI or CT scan is needed to get better detail of the fracture or to look for associated injuries to soft tissues such as ligaments or tendons.

During Distal Radius Fracture (Broken Wrist) Surgery

Treatment

Treatment of broken bones follows one basic rule: the broken pieces must be put back into position and prevented from moving out of place until they are healed.

There are many treatment options for a distal radius fracture. The choice depends on many factors, such as the nature of the fracture, your age and activity level, and the surgeon's personal preferences.

. Nonsurgical Treatment

If the broken bone is in a good position, a plaster cast may be applied until the bone heals.

If the position (alignment) of your bone is out of place and likely to limit the future use of your arm, it may be necessary to re-align the broken bone fragments. "Reduction" is the technical term for this process in which the doctor moves the broken pieces into place. When a bone is straightened without having to open the skin (incision), it is called a closed reduction.

After the bone is properly aligned, a splint or cast may be placed on your arm. A splint is usually used for the first few days to allow for a small amount of normal swelling. A cast is usually added a few days to a week or so later, after the swelling goes down. The cast is changed 2 or 3 weeks later as the swelling goes down more, causing the cast to loosen.

Depending on the nature of the fracture, your doctor may closely monitor the healing by taking regular x-rays. . If the fracture was reduced or thought to be unstable, x-rays may be taken at weekly intervals for 3 weeks and then at 6 weeks. X-rays may be taken less often if the fracture was not reduced and thought to be stable.

The cast is removed about 6 weeks after the fracture happened. At that point, physical therapy is often started to help improve the motion and function of the injured wrist.

. Surgical Treatment

Sometimes, the position of the bone is so much out of place that it cannot be corrected or kept corrected in a cast. This has the potential of interfering with the future functioning of your arm. In this case, surgery may be required.

. Procedure. Surgery typically involves making an incision to directly access the broken bones to improve alignment (open reduction).

Options for holding the bone in the correct position

Depending on the fracture, there are a number of options for holding the bone in the correct position while it heals:

. Cast

. Metal pins (usually stainless steel or titanium)

. Plate and screws

. External fixator (a stabilizing frame outside the body that holds the bones in the proper position so they can heal)

. Any combination of these techniques

. Open fractures. Surgery is required as soon as possible (within 8 hours after injury) in all open fractures. The exposed soft tissue and bone must be thoroughly cleaned (debrided) and antibiotics may be given to prevent infection. Either external or internal fixation methods will be used to hold the bones in place. If the soft tissues around the fracture are badly damaged, your doctor may apply a temporary external fixator. Internal fixation with plates or screws may be utilized at a second procedure several days later.

After Distal Radius Fracture (Broken Wrist) Surgery

What happens after cast or splint removal?

Once your provider determines the bone is clinically healed, the splint or cast is taken off and you can begin to move your wrist and forearm. You may be referred to Hand Therapy for instruction in exercises to regain motion and strength.

Your provider will let you know if there are any activities you should avoid and for how long – for instance, returning to contact sports or lifting weights.

What happens after Distal Radius Fracture (Broken Wrist) surgery?

Immediately after surgery you will be placed in a bulky post-operative dressing. This dressing must stay clean and dry until your first post-op appointment to minimize the risk of infection.

If you have pins, you will usually be put into a cast for 4-6 weeks. Once the cast is removed, the pins are pulled by your doctor either in the office or operating room (your hand surgeon will let you know which method will be used). You then will be referred to Hand Therapy for a removable splint, swelling and scar management, and exercises to regain motion and strength.

If a plate is used, you will typically be referred to Hand Therapy 3-5 days after surgery. Your hand therapist will remove the postoperative dressing, instruct you in swelling management and incision care, make a removable splint, and instruct you in range of motion exercises for your fingers, wrist, and forearm. Because the plate is holding your fracture in place from the inside, it is very safe to move your wrist and forearm early.

How long will it take to heal and what kind of results can I expect?

Fractures of the distal radius usually need about 4-6 weeks for clinical bone healing, though sometimes it can take longer. It may take another 6-12 months to regain motion, strength, and function. Many people find they are resuming most of their daily activities about 3-4 months after a broken wrist.

Will I need hand therapy?

Not all distal radius fractures require hand therapy to regain motion and function. However, many people can benefit from an appointment with a hand therapist for instruction in exercises to regain range of motion, strength, and function. Most people who have had surgery to repair the distal radius will see a hand therapist as part their recovery.

The number of hand therapy appointments you need will depend on how quickly you regain range of motion and function of your hand. Your hand therapist can give you a better idea of how much therapy you may need during your first appointment. Consistent follow-through with your home exercise program is a vital part of the recovery process.

Managing pain and swelling

It is not unusual to have pain and swelling while recovering from a distal radius fracture. Here are some suggestions to help you manage symptoms:

. Elevation – keep your hand and arm elevated above your heart as much as you can for the first several days after injury and/or surgery, then as needed, to minimize swelling (edema). This will also help to decrease pain.

. Ice – can be used 3-4x/day to help manage pain and swelling. Use a cold pack or a bag of crushed ice for 15-20 minutes at a time. It can be difficult to ice over bulky dressings or casts, but you can try putting the ice over your hand or just above the cast/dressing on your forearm. Do not use ice until your hand has “woken up”, if you had any anesthesia.

. Medication – such as acetaminophen (Tylenol), ibuprofen (Advil), or naproxen (Aleve) may help alleviate pain. In some cases, your doctor may prescribe other pain medication. Take medication as instructed to help minimize your pain.

. Vitamin C – 500 mg, 1x/day, taken for 50 days significantly reduces the risk of a complication called complex regional pain syndrome.

. Resume your daily routine as tolerated – this includes light exercise, such as walking, or riding a stationary bike. We also encourage you to try to use your injured hand for light activity such as dressing, eating, and computer use. Increase your activity as tolerated, avoiding things that cause increased pain at your fracture site.

. Nutrition – Drink plenty of water and eat healthy meals to give you energy and boost your body’s healing power.

. Move unaffected joints – Joints that are not included in your splint or cast should be moved through their full range of motion several times per day. This includes your fingers, thumb, elbow, and shoulder. It is especially important to keep your fingers flexible to prevent excessive stiffness, which can slow recovery of function once the cast or splint is removed. Feeling tightness, stiffness, pulling, stretching, and/or discomfort as you start to move is normal.

Additional recommendations

Following a distal radius fracture, performing your daily activities can be difficult and frustrating. It is okay to ask for help when you need it. Here are some suggestions to help you manage as you recover.

. Showering and bathing – if you had surgery or are in a non-waterproof cast, put a plastic bag over your arm to keep the dressings or cast dry. Your doctor or therapist will instruct you when it is safe to get your arm wet in the shower or bath.

. Driving – you must be off all prescription pain medication before driving. In general, you may resume driving when you feel safe and comfortable with the mobility of your arm and have stopped taking any prescription pain medications.

. Grooming and hygiene – use pump containers for soap, lotion and shampoo/ conditioners, spray shaving cream on the side of the sink and scoop to use, use pre-strung “flossers” to floss your teeth, keep caps loose on bottles and tubes to make them easier to open.

. Dressing – dress your injured arm first, avoid tight sleeves, slip your belt through belt loops before putting on pants, use slip-on shoes or keep them tied loosely so you can slide your feet in easily, hook bras in front and slide them around or use a camisole. In the winter, use a thick sock or hat to keep your hand warm when you’re outside.

. Cooking – keep meals simple. Buy pre-chopped or pre-packaged ingredients, use a pizza cutter or serrated knife to cut food, avoid using heavy pans that require use of both hands. Have family, friends, neighbors, or the supermarket cashier open tight or new jars and reseal them loosely to make it easier for you to open them at home.

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